The Washington Post - USA (2022-05-25)

wednesday, may 25 , 2022. the washington post EZ RE A

BY ELLEN FRANCIS

The spread of the monkeypox
virus has pushed the United
States and European countries to
evaluate their vaccine supplies
and possible treatments, even as
health officials said mass immu-
nization was not needed now.
Some health authorities have
also urged careful assessment be-
fore expanding the use of small-
pox vaccines to protect against
monkeypox.
The Centers for Disease Con-
trol and Prevention says the U.S.
stockpile includes over 100 mil-
lion doses of an older generation
of smallpox vaccine believed to be
effective against monkeypox, and
it is aiming to accelerate the
supply of a newer vaccine that
could help curb a potential out-
break. Its European counterpart
recommended on Monday that
countries update contact-tracing
systems and “review the availabil-
ity of smallpox vaccines, antivi-

rals and personal protective

equipment for health profession-

als.”

While studies suggest that

smallpox vaccine — given to some

military members and lab work-

ers — is at least 85 percent effec-

tive against monkeypox, accord-

ing to the CDC, the shot is linked

to rare, serious side effects such

as heart inflammation, the agen-

cy says. It recommends that peo-

ple with weakened immune sys-

tems or certain skin conditions

should not take it unless exposed.

Still, the CDC says that for most

people, the risks from monkeypox

are greater than from either vac-

cine.

The older smallpox vaccine

“has some potential significant

side effects with it, so a decision

to use that widely would have to

have some serious discussions

behind it,” Jennifer McQuiston, a

CDC deputy director, told report-

ers in a news conference Monday

after President Biden said the

country was exploring vaccine

options.

Any vaccine distribution now

would focus on people “that we

know would benefit from it,” such

as health-care workers or those

who came in close contact with a

confirmed case, she added. Many

countries, including the United

States, Britain, Canada and

France, stopped routine smallpox

vaccinations in the 1970s, as the

disease was eliminated around

the world.

German authorities have

warned that Europe is facing its

largest outbreak of the disease,

characterized by a rash and le-

sions that are the most significant

source of spread, such as through

skin-to-skin contact. In the Unit-

ed States, a single case was con-

firmed as of Monday, in Massa-

chusetts, with four potential cas-

es under investigation. More than

100 cases have been confirmed in

at least 13 other countries outside

West and Central Africa, where

the disease is endemic.

The U.S. stockpile has more

than 1,000 doses of the newer

vaccine, Jynneos, which is not

widely available and was ap-

proved in 2019 for the prevention

of smallpox and monkeypox, the

CDC’s McQuiston said.

“We expect that level to ramp

up very quickly in the coming

weeks, as the company provides

more doses to us,” McQuiston

said.

The company that developed

Jynneos has said the U.S. govern-

ment exercised its option for a

$119 million order that will allow

for a freeze-dried version of the

shot to be manufactured and in-

voiced in 2023 and 2024.

The European Center for Dis-

ease Prevention and Control said

smallpox vaccine doses could be

considered after exposure for

close contacts who are at high

risk, but it noted that more infor-

mation is needed on their use for

groups that face increased risk of

severe disease.

The World Health Organiza-

tion, which has a stockpile of

smallpox vaccine previously esti-

mated at 31 million doses, has

noted that immunity will prob-

ably be limited to older people

who were vaccinated before

countries such as the United

States stopped administering

shots to the public.

As Britain records a rise in

cases, it has offered a smallpox

vaccine to some health workers.

Meanwhile, Germany’s health

minister said the country was

evaluating vaccine options for

those who may be at risk but

noted that “vaccination of the

general population is not being

discussed.”

A senior WHO official echoed

those comments on Monday.

Richard Pebody, who leads the

high-threat pathogen team in Eu-

rope, told Reuters that the WHO

believes the monkeypox outbreak

does not require mass vaccina-

tion because hygiene and safe-sex

measures, as well as contact trac-

ing and isolation, can help to

control it.

He said immediate vaccine

supplies and antiviral treatments

were limited but added that the

virus does not spread easily. WHO

epidemiologist Maria Van Kerk-

hove also described the outbreak

on Monday as “a containable situ-

ation” and said stopping trans-

mission was possible.

The unexplained monkeypox

spread has raised some alarm as

the world reels from the coronavi-

rus pandemic, but health officials

have stressed that this virus is

neither new nor as easily trans-

missible. The latest spate of cases

stands out in part because many

have no travel links to countries

where monkeypox is more regu-

larly found, according to health

officials.

Annabelle Timsit contributed to this

report.

Nations evaluate supplies, but WHO says mass vaccination isn’t urgent

BY DANIELLE PAQUETTE

AND RAEL OMBUOR

DAKAR, Senegal — In a part of
Nigeria that has dealt with mon-
keypox outbreaks for years, one
doctor saw the photos circulating
in Western media this week and
chuckled.
“Those are the very severe cas-
es,” said Oyewale Tomori, a virolo-
gist in the nation’s southwest.
“Like, ‘Ahh! This is monkeypox!’ ”
The virus — discovered five dec-
ades ago in the Democratic Re-
public of Congo — causes mild
illness in most people, along with
blisters that usually clear up in
weeks, he said. It’s much less
transmissible than the corona­-
virus and much less deadly than
Ebola. There’s already an effective
vaccine.
What bothers infectious­disease
experts across the continent is the

double standard that has emerged

since monkeypox grabbed the

world’s attention: Few seemed to

care, or even notice, until people

in the West started getting sick.

In the past two weeks, cases of

the animal-borne virus typically

found in West and Central Africa

have popped up in the United

States, Canada, Australia, Israel

and a growing number of Euro-

pean countries. There have been

at least 92 confirmed infections

and no deaths. Belgium has im-

posed a 21-day quarantine. Presi-

dent Biden assured Americans

that the United States has enough

vaccine stocks to address the

threat.

Yet global alarm bells didn’t

sound as several African nations

battled outbreaks in recent

months. The graphic images blaz-

ing across social media — some of

the same ones used to illustrate

monkeypox since the 1970s —

rarely feature White patients.

“These cases are recorded in

Europe,” Tomori said. “Why are

you using a picture of an African?

Those are your pox.”

The World Health Organiza-

tion has not yet verified the origin

of the outbreak, though one WHO

adviser told the Associated Press

that the cases could be linked to

raves in Spain and Belgium. Mon-

keypox usually spreads by close

contact, including sexual activity.

Health officials suspect the vi-

rus has been traveling undetected

in nonendemic nations for some

time — potentially as far back as

2018. Early tests suggest cases
      stem from the West African strain,
      which the WHO said has a fatality
      rate of about 1 percent.
      Before monkeypox struck the
      West this year, the WHO said Ni-
      geria, Cameroon and the Central
      African Republic all recorded
      small case numbers. But contact
      tracing is limited, said Yap Boum,

a Cameroonian epidemiologist.

Infections tend to arise in remote,

forested areas, where people en-

counter wildlife that carry mon-

keypox, such as primates and ro-

dents.

“Maybe now that it’s happening

over there, the problem will get

more attention,” Boum said, “and

we will gain access to more vac-

cines, more treatments — all the

things we did not have the money

for.”

The Democratic Republic of

Congo has been battling the

world’s largest outbreak by far: at

least 1,238 cases and 57 deaths

since January. The strain found

there is also much more deadly,

with a fatality rate as high as

10 percent. Many deaths are pre-

ventable, doctors said, but treat-

ment can be hard to find in areas

with underfunded hospitals.

“It can be devastating in the

same way as covid-19,” said Health

Minister Jean Jacques Mbungani.

But the country’s monkeypox

preparations lost steam during

the pandemic. The nation needs

more tests, more inoculations,

more medical workers tracing

cases and caring for the ill.

“The response is not effective,”

Mbungani said, “and remains le-

thargic due to the scarcity of re-

sources.”

The European Center for Dis-

ease Prevention and Control said

Monday that the bulk of docu-

mented cases have been mild.

Young children, pregnant women

and people with weakened im-

mune systems face a heightened

risk.

One of Nigeria’s top genomic

sequencing experts, Christian

Happi, is inviting his counter-

parts to come study how his coun-

try has managed monkeypox.

“It’s not that scary here,” he

said. “People are used to it. Come

learn from our public health au-

thorities. Come see how we con-

tain it.”

The global enthusiasm to com-

bat the virus should have arrived

sooner, he said. Maybe it could

have been eradicated by now.

“Paying attention to disease

wherever it happens benefits ev-

eryone,” he said. “As the pandemic

has shown us, we are all in this

together.”

Ombour reported from Nairobi.

African doctors see a double standard in the global alarm over monkeypox

Most people didn’t care

about the disease until

it spread in the West

Andrew Medichini/Associated Press

Francesco Vaia, director of Italy’s main infectious-disease hospital,

talks to reporters after monkeypox cases were found in the country.

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